The Challenge Initiative (TCI) is a global platform that supports cities and local governments to rapidly and sustainably scale up proven primary health care solutions, particularly family planning. Rather than introducing new or parallel interventions, TCI transfers evidence-based strategies that are already known to work and supports local governments in institutionalizing these approaches within their own systems. By strengthening leadership, management, and data use at the local level, TCI achieves strong results at scale while promoting long-term sustainability. At a time of shrinking global health funding, this direction offers exceptional value for money—protecting past gains while enabling countries to expand impact with fewer external resources.

The year 2025 marked a challenging transition for TCI with its project completion. For country teams, including ours in the Philippines, 2025 raised critical questions about continuity, expectations, and sustainability. How would momentum be sustained? What would the next phase demand in terms of focus and capacity? And how could gains in family planning and adolescent, youth, and sexual and reproductive health be protected amid tighter global financing?

These questions were very much present as I travelled to Senegal to attend the TCI Global Chief of Party Meeting. There was a strong need for clarity on strategic direction, operating models, and performance expectations. Like many colleagues from other hubs, we arrived seeking reassurance and a clearer understanding of how TCI would move forward.

What the meeting ultimately provided was a shared perspective. Listening to the experiences of other hubs across Africa and Asia made it clear that the Philippines was not alone in navigating uncertainty. Many teams had faced similar transitions, pressures, and doubts. At the same time, they shared stories of adaptation, resilience, and continued impact. This collective reflection helped normalize the challenges of the past year and reinforced a shared sense of purpose across the global TCI community.

The discussions were grounded in realism. TCI is operating in a global environment where development assistance for health is increasingly constrained, making efficiency and focus more critical than ever. The meeting acknowledged these realities openly, including leaner global support structures and the need for greater hub-level autonomy. Importantly, this shift was framed not as a setback, but as an evolution toward a more mature and sustainable operating model.

For the Philippines, this message resonated strongly. Over the past years, TCI, in partnership with the Zuellig Family Foundation, has demonstrated its role as a powerful scale-up engine, enabling cities to rapidly expand access to modern family planning services using proven approaches. By working through local governments, TCI strengthens health systems, builds institutional capacity, and embeds data-driven decision-making where it matters most. These are not short-term wins, but foundational improvements designed to endure beyond external support.

This is precisely why TCI matters now more than ever. In a context of shrinking global health budgets, TCI’s model delivers high impact at relatively low cost. By leveraging existing systems, local leadership, and tested practices, TCI maximizes return on investment while reducing long-term dependence on donor funding. It protects what has already been achieved and enables countries to do more with less.

The global meeting reinforced this value proposition. Despite the uncertainties experienced in 2025, the collective results from the NextGen phase demonstrate TCI’s credibility and global reach. Across multiple countries, TCI-supported cities have reached millions of women with family planning services, contributing to healthier families and stronger communities. These results are measurable, well documented, and replicable across diverse contexts.

Encouragingly, the meeting also brought clarity and optimism about the future. Continued funding from Bayer, alongside ongoing discussions with other partners, signals sustained confidence in TCI’s approach. While resource mobilization remains a shared responsibility, the opportunity ahead is clear. TCI offers a compelling platform for donors seeking efficient, scalable, and sustainable investments in primary health care and family planning.

For our team in the Philippines, the meeting was both affirming and energizing. It validated the strategic direction we are taking under TCI 20.30, with an emphasis on prioritization, operational efficiency, and strong local ownership. Approaches such as clustered city support, streamlined reporting, and practical, on-demand access to knowledge at the facility level align well with the global push to simplify systems while safeguarding results.

Leaving the meeting, the uncertainty that characterized much of 2025 gave way to clarity, reassurance, and confidence. TCI is entering its next phase not as an untested initiative, but as a proven mechanism for translating global evidence into local impact. For governments, partners, and donors committed to advancing primary health care and family planning, TCI represents an opportunity to protect past investments and scale what works in a way that is efficient, locally led, and built to last.

Author: Dr. Anthony Faraon, ZFF TCI-Philippines Chief of Party

The Zuellig Family Foundation (ZFF), through its Bayang Malusog Leadership and Governance Program (BMLGP), is helping strengthen primary health care (PHC) systems in Kapangan and Kibungan in Benguet and Baguio City to support the country’s Universal Health Care (UHC) goals.

Guided by the UHC Act’s vision of accessible, equitable, and people-centered health services, the Bayang Malusog Program focuses on improving local leadership and governance so that government units can effectively manage integrated primary care networks. To support this, ZFF provided partnership grants to the City Camp and Irisan District Health Centers in Baguio City, and the Rural Health Units of Kapangan and Kibungan in Benguet.

Related articles:

• Kibungan and Kapangan’s Grand March Toward a Shared UHC Vision
• Baguio City Advance Universal Health Plans
• Moving Forward with Health Reforms in Benguet

The grants help frontline health workers deliver better care through:

• Home visit kits for community outreach;
• Personal protective equipment (PPE) for Barangay Health Workers (BHWs);
• Essential primary health care equipment; and
• Health Information System (HIS) support.

These tools enable continuous, quality care at the community level.

The turnover ceremony on January 22, 2025, marked a shared commitment to making primary care facilities strong and functional. Baguio City officials present were Dr. Ma. Lourdes Pakoy, Assistant City Health Officer; Dr. Nelson Hora, City Camp District Health Center Medical Officer; and Dr. Vanessa Fagcangan, Irisan District Health Center Medical Officer. From Benguet, Dr. Meliarazon Dulay and Dr. Jocelyn Legaspi, Provincial Health Officers, and Ms. Rubelyn Tomas, Senior Health Program Officer, attended, along with Dr. Joy Fermin, Municipal Health Officer of Kapangan. Department of Health-Cordillera Administrative Region officials Dr. Janice Bugtong and Dr. Mercedes Calpito also joined.

Through the Bayang Malusog Program, ZFF continues to show that strong leadership, well-supported health workers, and integrated primary care systems form the foundation of UHC—ensuring every Filipino family can access quality, responsive, and people-centered health services.

Banner photo: Provincial Health Office of Benguet

Authors: Joan Kidatan, ZFF BMLGP Associate for Baguio City

The Zuellig Family Foundation (ZFF) formalized a new partnership with the Philippine Health Insurance Corporation (PhilHealth) on December 3, 2025, through a Memorandum of Understanding (MOU) that strengthens ZFF’s ongoing work in building local health leadership and improving primary care systems in the Cordillera Administrative Region.

PhilHealth President Dr. Edwin Mercado highlighted the significance of the partnership. “This collaboration with ZFF will help us close gaps in the system. By educating providers, empowering local governments, and leveraging data, we can better align supply and demand in primary care and ensure communities get the services they need,” he said.

Related articles:

• Moving Forward with Health Reforms in Benguet
• Baguio City Advance Universal Health Plans

The MOU allows ZFF to work closely with PhilHealth’s Social Health Insurance Academy in co-developing and delivering training on social health insurance, supporting Provincial Health Boards and teams, and putting in place a joint monitoring and evaluation framework. These efforts will help improve registration to PhilHealth’s Yaman ng Kalusugan Program (YAKAP), first patient encounters, and the utilization of PhilHealth benefits—key areas aligned with ZFF’s mission to strengthen primary healthcare.

ZFF Chair Dr. Manuel Dayrit added, “This signing reflects our shared compassion and faith in serving communities. Even with limited resources, we can work together to transform primary health care. That transformation—the miracle we seek—is about comprehensive, connected, and continuous first-contact care that truly reaches those who need it.”

The signing marks another step in ZFF’s commitment to helping local governments build sustainable, community-centered health systems that ensure accessible and quality care for all.

The Department of Health-Cordillera Administrative Region (DOH-Cordillera) honored the Zuellig Family Foundation (ZFF) with the Gawad Kalusugan Award for its contribution to advancing Universal Health Care (UHC) in the region. The recognition took place during the Am-among for Health and Gawad Kalusugan on October 28–29, 2025, in Baguio City.

DOH-CAR recognized ZFF for its partnership in implementing the Bayang Malusog Leadership and Development Program (BMLDP), a joint initiative that builds the capacity of local leaders to strengthen health systems and improve health outcomes. The Bayang Malusog program continues to make an impact in its Community of Practice member areas, including Apayao, Mountain Province, Kalinga, Ifugao, and current Bayang Malusog Leadership and Governance Program sites Benguet and Baguio City, where empowered leaders sustain health reforms and deliver better services for their communities.

In her message, DOH-Cordillera Regional Director Amelita Pangilinan commended the efforts of partners like ZFF in empowering local government units (LGUs), saying, “The LGU is the lifeline of reform.” She encouraged continued collaboration to strengthen primary health care, improve facilities, and invest in the health workforce.

Related articles:

• Bridging Leadership in Action: Benguet’s Mayors Reaffirm Commitment to Universal Health Care Integration
• ZFF Bayang Malusog Community of Practice in 2025: A Renewed Commitment to UHC Learning

DOH Undersecretary Glenn Mathew Baggao urged participants to view UHC “not merely as a law, but as a commitment to collective effort for better health access.” He added that a ‘Healthier Cordillera’ requires building an inclusive, accessible, and resilient health system.

Through the Gawad Kalusugan, DOH-Cordillera also recognized outstanding LGUs, national agencies, civil society organizations, and private partners who help advance UHC in the region.

The recognition affirms ZFF’s commitment to work with DOH and LGUs in strengthening leadership and governance for health toward the shared goal of ensuring equitable and quality health care for every Filipino.

Main photo from: DOH-Cordillera

Author: Joan Kidatan, ZFF Local Health Systems Provincial Associate for Baguio City

Davao de Oro joined Aklan, Dinagat Islands, and Kalinga in celebrating a key achievement last March 2025—the successful completion of the Roberto R. Romulo (RRR) Fellowship for Public Health Leadership and Governance, a program led by the Zuellig Family Foundation (ZFF) in partnership with the University of the Philippines (UP) College of Public Health and the UP National College of Public Administration and Governance.

For Davao de Oro Governor Dorothy Gonzaga, the year-long fellowship was a transformational journey. “Coming from the judiciary and only entering politics in 2022, I never imagined how complex the health system really is,” she said. “This program helped me understand the power of leadership in turning health challenges into opportunities.”

Davao de Oro faced five key health concerns:

1. Child immunization coverage remains critically low. Only 63% of children were fully immunized in 2024—far below the national target of 95%. This gap leaves many children vulnerable to preventable diseases.
2. Teenage pregnancy continues to rise. In 2024, the rate reached 51 per 1,000 adolescents, which is significantly higher than both national and global benchmarks. 
3. The province’s hospitals are overwhelmed. The four provincial hospitals have a 315% occupancy rate, far above the ideal 80–85%, putting strain on both patients and health workers.
4. The province struggles with limited funding to properly manage its hospital system. To address this, the provincial government has proposed the renationalization of one hospital to improve funding and governance. 
5. Enrollment in the PhilHealth Konsulta program is still low. Only 8.4% of residents have had their first patient encounter, showing the need for stronger public awareness and engagement.

Despite the gaps, the province has made important strides. It tapped Barangay Volunteer Sanitation Inspectors to improve sanitation monitoring and prevent disease outbreaks at the community level. An information system was also developed that profiles and helps track Barangay Health Workers. 

The KoboCollect digital tool is being used to collect and manage data on water, sanitation, and hygiene. A provincial communication plan was also rolled out to improve field registration for primary health services.

In terms of services, the province exceeded national targets in prenatal care coverage, skilled birth attendance, and family planning. “These wins give us confidence that we’re on the right path,” she said.

The RRR Fellowship emphasized Bridging Leadership—the idea that real change happens when leaders bring people together. “I learned I can’t do it alone,” Governor Gonzaga reflected. “We need our mayors, health workers, and citizens to co-create solutions.”

Governor Gonzaga credits the Fellowship for sharpening her sense of purpose as a public servant. “I now see health not just as a service, but as a platform for empowerment and equity.”

In this case study, leadership plays a pivotal role in driving health systems reform in Balete and New Washington municipalities, with both mayors leveraging health leadership programs to achieve comparable health outcomes despite differing economic standings, demonstrating effective integration into the Aklan Provincial Health System and adherence to principles of Bridging Leadership essential for realizing Universal Health Care goals.

Health leaders and partners from Benguet gathered in Baguio City for a Program Implementation Planning Workshop under the Zuellig Family Foundation (ZFF)’s Bayang Malusog Leadership and Governance Program (BMLGP) last May 28-29, 2025. The workshop brought together stakeholders to assess Benguet’s current health landscape, agree on strategic interventions, and build a shared commitment to health leadership and accountability.

One of the major outcomes of the workshop was the identification of two critical focus areas: health data management and health financing. Participants noted the importance of improving how health data is collected, analyzed, and used. A stronger health information system would allow for more accurate monitoring of health indicators, better resource distribution, and faster responses to health concerns. Alongside this, the group highlighted the need for sustainable and equitable health financing. This involves making the most of existing budgets, exploring innovative ways to fund health programs, and enhancing the financial management skills of local health offices.

Twenty health leaders and staff from various agencies and local government units attended the two-day workshop. From the Benguet Provincial Health Office, Provincial Health Officer II Dr. Meliarazon Dulay, Provincial Health Officer I Dr. Jocelyn Legaspi, and Senior Health Program Officer Rubelyn Tomas joined the discussions. Benguet General Hospital was represented by Chief of Hospital Dr. Maria Imelda Ulep.

From the Department of Health (DOH), Dr. Mercedes Calpito, Melanie June Pucay and Sunshine Pisando attended. Sarah Jane Binaked represented the DOH Center for Health Development-Cordillera Administrative Region (CHD-CAR).

Representatives from the two pilot municipalities also played an active role in the workshop. From Kibungan, attendees included Dr. Hydre Nga-ew (Municipal Health Officer), Ivy Pasigon, and Letty Calawa. From Kapangan, Dr. Mary Joy Fermin (Municipal Health Officer), Charmaine Patil-ao, and Olivia Pantalone joined the group. Dr. Fabiola Gabriel, President of the Benguet Association of Municipal Health Officers of the Philippines (AMHOP), and Noland Sabling, Acting Chief Social Insurance Officer of PhilHealth Benguet, also took part.

With the implementation plan now in development, BMLGP is set to support stronger leadership, more effective governance, and improved primary care services in Benguet. The program will start with a focused approach in Kibungan and Kapangan supporting their health leadership and governance needs, with the goal of eventually expanding benefits to families across the entire province.